DE3035243C2 - Intestinal probe - Google Patents

Description

The invention relates to an intestinal probe made of a soft plastic tube with a balloon attached to the tip of the probe, which over a tube in the tube existing air duct is inflatable, and with suction openings at different points on the wall of the hose, which is activated by actuation at the probe inlet are optionally effective.

An intestinal probe of the aforementioned training is known from DE-OS 24 54 589. It consists of a outer tube and two inner tubes located therein. The space between the outside Hose and the two inner hoses serve as an air channel for inflating two spaced apart Fixation balloons. In the area between these is one arranged in the outer hose wall existing suction opening into the one inner hose opens, while another suction opening is available elsewhere on the outer hose wall which opens into the other inner tube as a drainage duct. Disadvantage of this intestinal probe is that it consists of a total of three tubes that overall result in a comparatively rigid probe. Furthermore, there are only two in different places arranged suction openings available, so that if a suction opening is blocked, the effectiveness of the entire section is omitted

DE-OS 27 11 977 describes an intestinal probe, which also has two inflatable balloons that can be inflated via associated air channels. Of the Tube has a gastric decompression channel, which forms the suction opening with its front mouth and at another distant place a bowel decompression canal, which is also free at its front The end of the suction opening is thus also at

of this intestinal probe only one for each discharge channel Assigned suction opening If these are blocked, the entire effective area is also switched off

By Willy Rusch, catalog (1968) IIUI.Gastroenterology. Surgery, Drainage, pages 22 and 23, a testinal probe is known which is located in a section of the The hose wall has several inlet openings. However, the inlet openings do not extend above different, individually lockable areas.

The present invention is based on the object of providing an intestinal probe that can be used in only one single suction channel selectable simultaneous or separate suction in several, extending over the length the probe extending sections through the individual section each associated with several Allows suction openings

To solve this problem, an intestinal probe made of a soft plastic tube with a balloon attached to the tip of the probe, which can be inflated via an air channel in the tube, and with suction openings at different points on the wall of the hose, which can be opened by actuation on the Probe input are optionally effective, proposed according to the invention that the hose in his In the longitudinal direction through a transverse wall into a main channel draining the secretions and an antechamber is divided. the suction openings are present in the hose wall forming the antechamber and the partition wall has a longitudinal through passage opening or several passage openings and in the antechamber there is a hose-shaped membrane which can be adjusted in terms of effect is inflatable and in its non-inflated position the passage of the suction openings Via the passage opening or several passage openings in the partition to the Hauptkanai leaves open and, in the inflated state, the passage openings between the antechamber and the main channel locks.

With the solution according to the invention, over a greater length of the probe in sections in the hose It is necessary to provide blown suction openings. in different areas of the intestine the To suck off intestinal secretions, the suction simultaneously, but also with regard to the individual sections in can take place in a selectable sequence. By activating the effective suction areas of the With the hose at the outer probe inlet, it is not necessary to move the probe for suction. Furthermore, it is ensured by the solution according to the invention that, in spite of the control option, the Suction openings in individual different sections of the diameter of the probe previously known Probes with respect to not need to change or only insignificantly and the external shape of the probe remains retained. At the same time enables the solution according to the invention due to the subdivision into one Main chamber and an antechamber that the intestinal contents through the main chamber unimpeded by the Control or shut-off elements in the antechamber can be discharged because the controls in the The area outside the main chamber is arranged so that the passage opening over the entire length Do not interfere with the main chamber.

In a further embodiment according to the invention, '^' is struck. that the envelope-shaped membrane in Jer V ^ rka ^ TC " ?. '; s rotating active sections, with air-conducting channels assigned to each active section being available for actuating each active section in the hose wall of the antechamber It is possible to inflate individual effective sections of the hose and not to blow out others or to provide a negative pressure in them. It is also possible to inflate all effective sections or to provide a negative pressure in all effective sections. This design results in a large number of possible variations By inflating the membrane to a greater or lesser extent and thus opening or closing the passages for sucking off the gastrointestinal contents, a control of the suction rate per unit of time can be achieved.

In a further embodiment of the invention it is proposed that the tubular membrane in three active sections is divided and in the hose wall of the antechamber three air-conducting Channels are arranged, each channel assigned to the corresponding area of action of the membrane, one or more, located in the hose wall of the antechamber and in the respective associated section of the membrane has opening air openings

Another suggestion is that the tubular membrane on the inner wall of the antechamber opposite the passage opening in the partition between the antechamber and the main chamber and in jo their starting position is flat, to both Sides of the membrane in the hose wall of the antechamber just above the partition are the suction openings are present and the air-conducting channels for inflating the membrane in sections next to one another and are arranged running parallel to one another in the hose wall of the antechamber.

Another suggestion is that the tubular membrane with the hose wall of the Antechamber is in one piece At the same time, it should be particularly advantageous in its starting position and at its Partition wall with passage openings facing sides with one designed in the manner of a bellows Be provided with a profile.

The invention is shown by way of example in the drawing Ί5 It shows

F i g. 1 shows an intestinal probe in side view,

F i g. 2. a vertical section through the probe according to Fi g. 1 corresponding to the local line 1-1,

F i g. 3 shows a vertical section through the probe according to FIG. 1 corresponding to the local line 11-11,

F i g. 4 a longitudinal section through a probe,

5 shows a longitudinal section through a modified one Probe,

F i g. 6 shows a vertical section through the probe according to FIG. 4 according to the local line VI-VI,

F i g. 7 shows a vertical section through the probe according to FIG. 5 corresponding to the local line VII-VII,

F i g. 8 shows a vertical section through the probe according to FIG. 5 corresponding to the local line VI11-VI11,
9 shows a longitudinal section through a probe with a modified control of the membrane through a valve body,

10 shows the probe according to FIG. 9 by using Vacuum partially deformed valve body,

F i g. 11 the control of the valve body in a schematic Depiction,

FIG. 12 shows the position of the valve body in FIG. 11 in relation to another position.

F i g. 1 shows the probe 10. It consists of soft thermoplastic and kink-free plastic, such as PVC, polyethylene or polyurethane. It preferably has an oval cross section with an outer diameter of six millimeters wide and seven millimeters high, with a wall thickness of one millimeter and a total length of approximately three meters. At its front end it is provided with a known balloon 11 which can be inflated via an air-guiding duct 26 of known design that is present in the wall 11 of the hose. In the area of the balloon tip, usual suction openings 12, 12a, 126 are arranged in the wall of the tube over a distance A of approximately eight centimeters. The well-known irrigation channel leading to the tip of the first hole of section A is let into the main chamber. According to the present invention there are further suction openings 13, 13a etc. in section B and 14, 14a, Hb etc. in section C and 15, 15a etc. in section D. 2n will be discussed below. At least in sections B, C and D and E of the probe, air-conducting channels 16, 17 and 18 are assigned, the position and mode of operation of which will be described later. The suction or drainage bag 19 is also attached to the end of the probe.

Now that the basic structure of the probe has been explained, details are given in conjunction with the F i g. 2 and 3 received. The hose 10 has a central partition wall 20 so that it is divided into a main chamber 21 and an antechamber 22. This partition wall 20 is when the main chamber is located below slightly curved, so that the antechamber is slightly sickle-shaped and the main chamber is rounded Has flow cross-section. In the partition 20, transverse wall holes 23, 23a etc. may be present, as shown in FIG. 4 is shown. In terms of extruding the tubing, it is however, it is advisable to provide a longitudinal slot 25 so that the partition wall from the Section 20 and section 20a consists, as shown in FIGS. 2 and 3 as well as in FIGS. 5, 7 and 8 shown is. In the upper wall section 24, which delimits the antechamber 22 at the top, are on both Sides above the transverse wall 20, 20a suction openings 13 are arranged. These are two in height Millimeters with a length of three millimeters with a distance of 15 mm. These suction openings are to the inner transverse wall holes 23 according to Figure 4 offset by an amount of five millimeters prevents the main channel 21 from being clogged by a sucked-in intestinal mucous membrane.

On the upper wall of the antechamber 22 there is a thin, hose-like plastic membrane 27, which is particularly advantageous in one piece with the hose and has a wall thickness of approx. 0.1 to 0.2 mm This membrane has in its initial state, i.e. after production, a kind of a Bellows-shaped profile. According to Fig.2 it is S-shaped. According to FIG. 6 it is on the to the transverse wall 20 t> o directed side wavy, according to F i g. 7 zigzag shape.

F i g. 3 shows that the membrane 27 is inflated and is in sealing contact with the upper longitudinal edges of the slot 25
FIGS. 2 and 4 show that the membrane 27 is connected to the channel 17 via an opening 28 or several openings 28a.

According to the exemplary embodiment according to FIGS. 2 and 4, left-hand part, there is no compressed air in the channel 17, so that the membrane 27 assumes its starting position or rest position. There can also be a negative pressure in the channel 27, so that the membrane 27 rests against the wall of the antechamber. According to FIG. 2, it is possible that the intestinal contents in the area between the outer wall of the probe and the inner intestinal wall reach the main channel 21 via the suction openings 13 and the opening 25 between the transverse wall sections 20, 20a or transverse wall openings 23 and can be withdrawn there. F i g. 4 shows in the right part, that the diaphragm 27 rests in the acting portion Can of the intermediate wall 22, because through the channel 16 shown also in Fig. 3 through the openings 29, 29a compressed air is blown into the membrane, so that it is in the acting portion C results in a closed position and there no suction can take place via the suction openings 14,14a.

In order to be able to reach the individual effective sections of the membrane, it can be used in the areas over the effective sections B, C and D, which are extended over two meters in length, as shown in FIG. 4 shows to be connected to the wall of the antechamber by heat sealing or gluing 30. However, it is also possible that the connecting openings between the air-conducting channels and the membrane are always only assigned to the active section in the assigned channels 16, 17 or 18, so that, as FIG is sucked in at the top, while when pressure is applied in the channel 16, air pressure is brought into the membrane via the openings 29, 29a, so that it rests against the wall 20 there.

F i g. 6 shows the membrane 27 as a separate component that is glued to the wall of the antechamber 20. In order to achieve this, the tube has been cut open at point 30a and the tube half lifted off so that the membrane could be attached. At the same time, the passage openings 28 and 29, assigned to each effective section, have been attached beforehand. The hose is then closed again at the cutting line 31 by gluing, heat sealing or heating and the application of pressure. The measure described above also makes it possible to provide openings 23 located at a distance from one another in the wall 20, specifically preferably only in the areas B, C and D.

7 shows the proviso that the membrane 27 is integral with the wall of the hose zigzag training. There is a gap 25 between the sections 20 and 20a of the transverse wall present, which is longitudinal

Fig.8 shows the solution according to Fig.7 in a Membrane that is inflated

The attachment of the connecting holes 28 and 29 between the channels 16 and 17 can be done in the manner take place that this from the outside by drilling or the like. be attached in the connecting wall, then subsequently the opening in the outer Hose wall is closed again, namely by heat sealing or gluing.

The drawings show that the main chamber 21 has a constant cross section and through the actuation of the diaphragm is not hindered

In Fig. 2 is shown that on the outer surface of the

Tube an X-ray strip 31 is present, which has a different identifier assigned to the section B than in the adjacent section C. There, the sections of the linear extension of the X-ray strips are of greater length. It follows that in the individual action sections A. B, C and D X-ray strips with different identifiers are arranged. This identifier is preferably also present at the connections 16a, 17a and 18a, which are assigned to the control channels 16, 17 and 18, respectively. While the F i g. 6, 7 and 8 show essentially schematic representations, FIGS. 2 and 3 show, in corresponding enlargement, special advantageous spatial shapes, in particular with the proviso that the tube has an oval cross-section and the antechamber is of smaller cross-section than the main chamber and furthermore Main chamber is limited at the top by a curved partition.

9 to 12 show the solution that the tubular membrane 27 is designed to be continuous in the action sections B, C and D , so that an overall action section y , shown schematically in FIG. 11, is present. The membrane is provided at its front end with a passage 16a via a passage 29a and at its opposite end with the passage 28a via a passage 17a . Inside the tubular membrane 27, the cross-section of which is preferably round in the inflated state, there is a valve body 32 adapted to the cross-sectional profile, approx. 3 mm long and double-cup-shaped in cross-section because it has a concave recess 33 and 34 on both end faces , which from Fig. 9 emerges If, according to the illustration in FIG. 9 is introduced via the channel 17a with the passage 28a water under excess pressure and the in F i g. 10 is left open channel 16a , the valve body is shifted steplessly in the total effective section y to an intended location. This is achieved by reducing the water pressure, which occurs through a syringe and can be finely regulated.

F i g. 9 shows that the valve body is displaced towards an opening 25 in the partition 20 has been. By applying negative pressure in the channel 16a, the membrane is opened via the passage 29a raised upwards so that the gastrointestinal contents via the passages 13 in the wall of the antechamber can be extracted in the corresponding section of activity.

F i g. 11 and 12 show the solution according to FIGS. 9 and 10 in a different representation. The valve body 32 within the membrane 27 is shown in FIG. 11 moved in the indicated arrow direction 36 by injecting water through the opening 37 into the channel 16a. At the same time, the channel 17a with the connecting opening 28a to the membrane is open. After the valve body 32 has been moved to a predetermined point by the water pressure, a high negative pressure is generated in the membrane via the channel 17a by means of syringe evacuation, so that the tubular membrane collapses on the associated side and prevents further unwanted displacement of the valve body, even if there is overpressure on the opposite side of the valve body to close the partition openings between the antechamber and the main chamber. In this state, the probe is ready to suck off the gastrointestinal contents on the evacuated side of the membrane. In analogous rearrangement of the manipulations listed above, the suction effect of the probe can be varied locally and continuously in any order by moving the valve body, depending on the clinical requirement.

Fig. 12 shows the proviso that the water is pressed through the channel 17a via the connecting opening 28a into the tubular membrane and the channel 16a iü is open, so that the valve body 32 is pushed in the indicated arrow direction 35 to a previously determinable point. The valve body is preferably made of a soft silicone rubber with an X-rayable impregnation so that its position can be recognized in the X-ray image.

In a further embodiment there is the possibility of moving the valve body slowly back and forth over the effective section Y by means of an automatically controlled pump and evacuation system, for example in such a way that a passage extends over a period of half an hour, so that all occupied Gastrointestinal sections can be disposed of in regular chronological order of their contents by permanent suction through the main chamber.

To FIGS. 11 and 12, it should be noted that the channel could also be omitted 17a with the passage opening 28a, because it is possible, the application of pressure or negative pressure in the membrane urmittelbar initiate I'i th, so that the control of the Valve body only needs to be present in one control channel 16a in the wall of the antechamber.

The clinical application can be:

_Γ) 1. Preoperative

a) All membrane segments are inflated so that only?, n of the probe tip are the suction holes are open.

b) Introduction of the probe according to the well-known Miller & Abbot method or Armierung the probe over 1.5 m with a 0.? mm thick spring steel wire counted from the probe tip.

c) Introducing the probe through a nostril and pushing it forward into the stomach.

d) Demonstration of the probe tip under fluoroscopy using the wire guide over the Gastric exit into the duodenum. By gradually withdrawing the guide wire

The probe can then go further by approx. 10 cm be advanced.

e) The guide wire is removed and the tip balloon inflated so that it fits with the peristalsis of the The intestine moves on and the probe takes it with it. Application of continuous suction of 15-20 cm H2O

at the beginning of the probe (main chamber).
Q The membrane segments are only emptied via the wall ducts when they have completely passed the stomach entrance, so that the associated probe section can now take part in the suction process of the gastrointestinal contents,
g) Once the probe has finally been placed, the individual segments are switched on or off depending on the clinical requirements, ie the local intestinal distension and stasis.

2. Intraoperatively

According to the aforementioned basic features.

Inflation of the pointed balloon lying in the stomach, advancement to the gastric outlet, emptying of the Tip balloons, advancement over the gastric outlet, re-inflation of the tip balloon and advancement into the small intestine, which is now sucked off through the terminal holes. Placement of the probe in the small intestine, its tip optionally in the initial part of the large intestine, emptying of the tip balloon.

3. Removal of the probe

Gradually by carefully pulling over a longer period of time (hours possibly), if necessary under X-ray control. The complete patency of the intestinal tract should be achieved beforehand by the application of contrast media can be checked radiographically via the probe.

IO

4. Indication areas

a) Mechanical and paralytic Heus dei verschic the most common causes in combination with the operative intervention.

b) Peritonitis for long-term postoperative decompression after intraoperative insertion of a probe.

c) In principle for all those abdominal surgery who postoperatively had a protracted medication

Gastrointestinal intestinal tract difficult to control

with high pressure of the diaphragm and obstruction of the respiratory function must be feared.

d) Intraluminal splinting in the case of recurrent hesionic ileus.

e) Mainly for the conservative treatment of otherwise uncontrollable paralytic lleus states of the international administrative area, if a surgical indication is not given.

For this purpose 3 sheets of drawings

Claims (12)

Patent claims: 1. intestinal probe made of a soft plastic tube with a attached to the probe tip Balloon that can be inflated via an air duct in the tube and with suction openings at different points on the wall of the hose, which can be activated by actuating the probe inlet are optionally effective, characterized in that the hose (10) in his In the longitudinal direction through a transverse wall (20, 20aJ into a main channel (21) and draining the secretions an antechamber (22) is subdivided, the suction openings (13,14,15) in which the antechamber forms Hose wall (24) are present and the partition (20) is a longitudinally continuous one Has passage opening (25) or several passage openings (23) and in the antechamber (22) one tubular membrane is present, which is inflatable in adjustable effective sections and in its non-inflated position the passage of the suction openings (13,14,15) via the Passage opening (25) or several passage openings (23) in the partition (20, 20aJ closed leaves the main channel (21) open and, in the inflated state, the passage openings (25, 23) blocks between antechamber (22) and main channel (21) 2. Intestinal probe according to claim 1, characterized in that the tubular membrane (27) in the antechamber (22) consists of several effective sections (B, C, DJ) and each effective section with a control channel (16) located in the tube wall of the antechamber (22) , 17,18 etc.) is connected. 3. intestinal probe according to claim 2, characterized in that the tubular membrane (27) is divided into three or more effective sections (16, 17, 18, etc.) and in the hose wall the antechamber three or more air-conducting channels (16, 17, 18, etc.) are arranged, wherein each channel, assigned to the corresponding area of action of the membrane, one or more in the Air openings (28,29 etc.) has. 4. intestinal probe according to claims 1 to 3, characterized in that the tubular Membrane (27) on the inner wall of the antechamber (22) of the passage opening (23, 25) in the Partition wall (20) between antechamber (22) and main chamber (21) is opposite and in their The starting position is flat, on both sides of the membrane in the hose wall of the Antechamber (22) just above the partition (20) the suction openings (13,14,15) are present and the air ducts (16, 17, 18 etc.) for inflating the membrane (27) in sections arranged next to one another and running parallel to one another in the hose wall of the antechamber (22) are. 5. intestinal probe according to claim 4, characterized in that the tubular membrane (27) is integral with the hose wall of the antechamber (22) 6. intestinal probe according to claim 5, characterized in that the tubular membrane (27) on its partition (20) with the passage openings (23, 25) facing side with one after Is provided on a bellows formed profile. 7. intestinal probe according to claim 1 and one 5 or more of claims 2 to 6, characterized in that the hose over its length in different areas of suction openings (13, 14, 15) with an X-ray strip (31) different identifier is provided ίο 8. intestinal probe according to claim 1, characterized characterized in that in the membrane (27) a predeterminable by air or liquid Position movable Veniilkörperchen (32) is arranged, through the local position of the effective section the membrane is determined 9. intestinal probe according to claim 8, characterized in that the valve body (32) through at least one control channel (16aJ, which is present in the wall of the antechamber and which is shown in the membrane (27) opens, is controlled. 10. intestinal probe according to claims 8 and 9, characterized in that the valve body (32) has one on each of its two end faces has a concave recess. 11. intestinal probe according to claims 8 and 9, characterized in that the valve body (32) consists of a soft silicone rubber. 12. intestinal probe according to claims 8 to 11, characterized in that the valve body (32) is provided with a radiopaque substance